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Use of specified health services by young people

Export Indicator

The use of specified health services by young people can be measured through either facility-based records (measuring service utilization only) or population-based methods such as surveys (which can give an estimate of the coverage of health services). 1)
What it measures

1) Facility-based This indicator tracks the number of young people seeking health services and the proportion of all clients of health services who are young people. It can be an estimate of the changes in care-seeking behaviour among young people. It is well known that young people do not access health services in proportion to the health problems experienced in this population. A basic aim of an HIV/AIDS prevention programme, therefore, is to increase the use of services by young people, specifically for STI testing and treatment, family planning /contraceptive use, and HIV testing. This indicator provides the crude numbers and the proportion of all clients, per specific service if possible, who are young people. Generally, an increase in the number and proportion of young clients is considered positive. However, the number and the proportion must be interpreted together, as the proportion of clients who are young people may decrease if the use of clinics by adults increases, even though the number of young clients may be increasing as well. The correct interpretation of these numbers, moreover, requires some population-based estimates to be available, because it is necessary to know the magnitude of need in order to interpret increases or decreases in service use. For example, if it is known that 40% of the population served by a particular health service are young people aged 20–24, and that in this population the prevalence of Chlamydia is 20%, an estimate can be obtained of the maximum number and proportion of young clients who could, ideally, be expected to seek STI testing and treatment. In other words a ceiling is provided against which to gauge the increase or decrease in young clients.
2) Population-based This indicator estimates the proportion of sexually active young people who report seeking specified health services. In addition, if data are available on the proportion of young people in need of specific health services, either through epidemiological estimates or other surveys, this measure can be an estimate of the coverage of the specific health services. For example, if it is known that in a given region the proportion of sexually active females in the 15-19 age group is 50%, this provides a benchmark against which to gauge the number and proportion of females aged 15-19 years who report seeking health services in order to obtain contraceptives. If more details are known about sexual risk behaviours (e.g. if, of the 50% who are sexually active, 40% report more than one partner in the preceding year and only 30% report frequent use of condoms) they can be benchmarks for the proportion of girls aged 15-19 who would potentially need HIV testing services.

Rationale
Numerator

1) Facility-based: the number of young people using a specified health service in a defined period. Health services of particular interest include those concerned with HIV testing, STI diagnosis and treatment, and family planning / contraceptive use. 2) Population-based: the number of young people who report receiving any of the specified health services (HIV testing, STI diagnosis and treatment, and family planning / contraceptive use) in the preceding12 months.

Denominator

1) Facility-based: clients using a specified health service in a defined period. 2) Population-based: young people surveyed who report being sexually active (have ever had sex).

Calculation
Method of measurement

1) Facility-based The minimal data required for this indicator are obtained by disaggregation of all clients by age and by sex. The focus is on primary care facilities. However, depending on the setting, the use of other types of facilities can also be tracked. Data can be collected from a nationally representative sample of health facilities. A brief discussion on sampling health facilities appears in the final paragraph on indicator No. 4 in this chapter. Data can be obtained from record books, logbooks, etc. used by facilities to keep track of clients. The number of clients who are young people is summed for a defined period. In facilities that are youth specific the period chosen may be short, e.g. a month; however, in facilities where young people are a small proportion of the client load the period must be extended to capture enough young clients. The proportion of clients in a chosen time frame who are young people can also be calculated by dividing the number of young clients by the total number of clients during the period in question. These data can be summarized at several points in time so as to provide an idea of the trends in service use. Whenever possible the type of service provided should be specified. With regard to HIV prevention programmes for young people, at least the following services should be specified: STI testing and treatment, family planning services and HIV testing. Depending on the setting (both the level of the epidemic and the existence of a facility-based tracking system), PMTCT and antenatal care services can also be specified, as well as needle exchange services. In most resource-constrained settings, however, these specifications are impossible. In this circumstance it is of value simply to record young clients by age, sex and the type of service sought. In settings with more sophisticated tracking systems, first visits should be distinguished from followup/ repeat visits. First visits measure the increase in uptake of the services. Follow-up/repeat visits may reflect continued treatment (e.g. a first visit for an HIV test and a second visit for obtaining the result), or a recurring health problem (e.g. a return visit because of an STI that had not been successfully diagnosed or treated). Other important characteristics of young people using the services should also be measured (e.g. rural/urban status), as this can provide useful information on the portion of the population not using the services.
2) Population-based Data are collected through population-based surveys in which respondents are asked whether they have received specified services. Most often, such questions are put only to respondents who report being sexually active (have ever had sex). If the question of service utilization is asked of all young people, those who have never had sex should be excluded from the denominator.  A defined time limit must be specified in the service utilization question. This can be defined on a national level (12 months is proposed here). For HIV prevention programmes among young people, at least the following services should be specified: STI testing and treatment, family planning services and HIV testing. The question put is as follows. Did you receive any of the health services listed below during the past 12 months?
• STI diagnosis or treatment.
• Family planning / contraceptives.
• HIV testing.
The numerator comprises the number of respondents who report having used any o

Measurement frequency

Periodic

Disaggregation

Age group:

Education: N/A

Gender: Male, Female

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

1) Facility-based The strength of this indicator is that it uses existing service-based mechanisms of data collection and record-keeping. In settings with sufficient resources a simple coding scheme can be established both to code the type of service received and to distinguish first visits from repeat visits. If this is impossible, however, valuable information is obtainable by simply tallying the total number of young clients. As these data build on monitoring systems, they are ideally collected continuously throughout the year. Trend data should be observed at intervals, e.g. quarterly, and not only at specific points in time, because service utilization is affected by seasonal events. In each setting the important sociocultural events should be recognized, but at least the local school year and major religious holidays should be taken into account when collecting and interpreting the data. It should be kept in mind that an increase in the number of young people seeking services does not necessarily mean an increase in the proportion of young people with health needs or issues. The increase may well be attributable to other factors, such as an IEC campaign advertising the services or a health promotion programme that enables more young people to recognize the need for services, e.g. to recognize the symptoms of an STI or to increase the demand for contraceptives. A major weakness of this indicator is that it depends on facilities having well-maintained and accurate records and logbooks, including age-specific records or at least records in age brackets allowing for disaggregation of young people from adults. In many countries there may be no such records, or the recording of services in facilities may not be standardized, i.e. some clinics may keep updated and well-maintained records whereas others may not. Even where well-maintained clinical records exist by measuring the quality and effectiveness of health services. the way in which the information is recorded may limit the ability to collect data for this indicator. For example, some facilities include STI diagnosis and treatment under the overall heading of “outpatient services” but do not break them down into further categories or causes. In this circumstance it would not be possible to collect data on the number of young people diagnosed and treated for STIs. Consequently, it is very important to determine how facility records are maintained and what type of information is recorded in the medical/service records before data on this indicator are collected. In settings where a majority of facilities do not keep age-disaggregated data this type of information would be impossible to collect. In such situations it would be necessary to explore the feasibility of improving the record-keeping system at the outset so that age brackets for young people were included.
2) Population-based The strength of this indicator is that the questions leading to its measurement can be incorporated into a population-based survey. The questions should be carefully formulated to include a realistic time dimension because, in most settings, adolescents seldom seek these services. As with facility-based estimates, an increase in the reported need for services does not necessarily mean an increase in health problems, but may be attributable to IEC programmes or other factors that increase awareness of health issues and can prompt preventive or curative behaviour. Moreover, the measurement of service utilization provides no information about the qualit

Further information